MEDICARE: DR. CARLA GAVILANES GASPARINI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5858 TG	TX

General Provider Information

NPI Number	:	1922142231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLA GAVILANES GASPARINI O.D.

Provider Business Mailing Address
First Line	:	12407 N MO PAC EXPY STE 100
Second Line	:	PMB 296
City	:	AUSTIN
State	:	TX
Zip	:	78758-2429
Country	:	US
Telephone Number	:	512-345-2595
Fax Number	:

Provider Business Practice Location Address
First Line	:	9300 S I H 35
Second Line	:	BLDG B
City	:	AUSTIN
State	:	TX
Zip	:	78748-1733
Country	:	US
Telephone Number	:	512-345-2595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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